2008 report found system failed to make use of unused appointments

San Diego’s Veterans Administration health-care system has had its own issues with patient scheduling — problems that were indirectly referenced in a federal report leading to the resignation on Friday of VA Secretary Eric Shinseki.

While the Office of Inspector General report does not specifically mention the San Diego system, it references a December 2008 audit that found San Diego was one of six veterans’ health-care systems that failed to “accurately measure and report unused outpatient appointments” at medical clinics.

As a result, an estimated 16 percent of open appointments in the San Diego system were not made available to veterans who needed treatment.

Document

“Over the last couple of years, we’ve made aggressive strides to fix all of that,” said Cindy Butler, spokeswoman for the San Diego VA system. “We’ve worked with patients to reduce the no-show problem. We’re checking on every appointment to make sure they’re fully booked. We even try to call the same day if there’s a cancellation.”

Butler said a recent department review found the San Diego VA system was in compliance with department scheduling practices, but the system is still not able to match every cancellation with a veteran who needs care.

The department’s flawed scheduling practices were thrust into the national spotlight after CNN reported that 40 veterans had died while waiting for treatment in the Phoenix veterans’ health-care system. Reports there and elsewhere have uncovered elaborate systems for hiding backlogged patient care with fake reports and duplicitous logs, but no such thing has been alleged in San Diego.

In a May 28 report, Richard Griffin, the VA’s acting inspector general, said his office was investigating widespread deficiencies throughout the system.

“We are finding that inappropriate scheduling practices are a systemic problem nationwide,” Griffin wrote in the report. “One challenge in these reviews is to determine whether these practices exist currently or were used in the past and subsequently corrected by VA managers.”

Since 2005, the VA’s Office of Inspector General has published 18 reports on medical scheduling practices that have led to “lengthy waiting times and the negative impact on patient care,” Griffin wrote.

Document

The VA had set yearly performance goals to help book patients for cancelled appointments, but the 2008 audit found that San Diego did not meet the targets in eight of 10 categories. Overall, San Diego ranked second worst of the six systems, slightly behind Boston, and it ranked worst in unbooked appointments for primary care, orthopedics, dermatology and eye care.

The audit estimated that the six networks had 4.9 million unused appointments that year. The estimated cost of those appointments was $564 million.

Forty percent of primary care appointment slots are currently unused in San Diego, but Butler said that is because the San Diego VA is now leaving more slots open for walk-in appointments and to allow doctors to follow up with patients by phone. Eleven percent of specialty care appointment slots are currently unused, Butler said.

The majority of new patients in the San Diego VA system were seen within 14 days, and all new patients were seen within 90 days, Butler said. Nearly 76,000 veterans receive health-care from the San Diego VA.

“More than 99 percent of our existing primary care patients, and 98 percent of specialty care patients, are seen within 14 days of their desired appointment date,” Butler said.

Despite improvements after the 2008 report, problems in the San Diego VA system resurfaced last year in an Office of Inspector General review of appointment practices at a patient call center. A call center employee had neglected to schedule an appointment he had promised to a veteran with an infected finger. The man sought treatment in the emergency room of a community hospital when no one from the VA followed up with him, the report said.

“People are generally, in our experience, very satisfied with the VA in San Diego,” said Rep. Scott Peters, who represents San Diego’s 52nd Congressional District. “The delays are still large, but smaller than in other parts of the country.”

In August 2007, the VA health-care system’s national leadership board released a report recommending strategies to reduce the number of unused appointments, but the VA still has not streamlined its approach nationwide.

The May 28 inspector general report found that 1,700 veterans in the Phoenix system who were in line for primary care appointments were not on the official waiting list. Dr. Sam Foote, a retired VA doctor, told CNN that managers in the Phoenix VA had created a secret wait list to conceal the real number of veterans who needed treatment.

Griffin announced in the report that he was sending out rapid response teams to investigate allegations of misconduct at 42 VA medical facilities around the country.

“We are not providing VA medical facilities advance notice of our visits to reduce the risk of destruction of evidence, manipulation of data, and coaching staff on how to respond to our interview questions,” Griffin wrote.

2008 audit report on VA health systems

Clinic Type

Yearly Target

San Diego

Muskogee, OK

Lexington

Sheridan, Wyo.

Boston

Northport, NY

Audiology

7

7

8

5

10

6

6

Cardiology

12

13

6

14

6

8

12

Dermatology

12

18

*

9

*

16

14

Eye Care

13

19

16

8

12

18

13

Gastroenterology

17

17

26

8

*

26

19

Mental Health

17

19

15

32

21

19

18

Orthopedics

12

15

9

9

*

14

11

Podiatry

12

17

16

24

15

17

11

Primary Care

11

15

11

11

7

13

10

Urology

13

15

17

11

*

17

16

Average

12.6

15.5

13.78

13.1

11.83

15.4

13

Median

12

16

14.39

10

11

16.5

12.5

Percent of cancelled appointments not booked for patients on waiting lists. An asterisk means the services are not provided in that system.